Malaria

Malaria is a serious and occasionally fatal disease, caused by the protozoan parasite Plasmodium. This plasmodium parasite usually infects the female Anopheles mosquito which feeds on human blood. Through the bite of an infected female anopheles mosquito malaria transmits from mosquitos to humans. 
Once entered the human body, the parasite (sporozoite) travels to the liver and replicates and stays in a vegetative state for about 10 days to 4 weeks. Later, the parasite transforms into merozoites, ruptures the liver cells, and enters the red blood cells (RBC) where the reproduction occurs. In this stage, the typical signs and symptoms of malaria develop. The symptoms might develop anywhere from one week to one year after being infected by the parasite. The symptoms of malaria include fever associated with chills, headache, abdominal pain, diarrhea, nausea, and vomiting. When an uninfected mosquito bites the malaria-infected human, the plasmodium parasite(gametocyte) enters the mosquito and stays in the gut develops in the salivary glands of the mosquito, and spreads to other humans through the bite. 
Recently World Health Organization (WHO), has recommended a vaccine for malaria which is available under the brand name mosquirix. It is given to children aged 5 months to 2 years in 4 doses with the first 3 doses given one month apart and the 4th dose given after 15 to 18 months after the 3rd dose. The vaccine helps reduce hospital admissions in severe cases of malaria. 

If you suspect you may have Malaria or have risk factors for one, it is crucial to consult with a General Physician.

Causes

Malaria is a serious and occasionally fatal disease caused by the Plasmodium parasite that usually infects the female Anopheles mosquitoes which feed on human blood. 

Five kinds of malarial parasites infect humans 

• Plasmodium falciparum  
• Plasmodium vivax  
• Plasmodium ovale  
• Plasmodium malariae
• Plasmodium knowelsi

The most common malarial parasites in India are P. falciparum and P. vivax 

Risk Factors

• Living or traveling to malaria-endemic regions, which includes tropical and sub-tropical regions.
• Mosquito breeding sites like  
• Stagnant water
• Temporary pools and ponds after rains
• Tree holes that retain water
• Air conditioner drip trays
• Tree stumps and woodpiles
• Water retaining in old tires after rain 

Individuals like infants, children under 5 years of age, pregnant women, and patients with HIV/AIDS are at considerably high risk for contracting malaria and developing severe disease in comparison to others. 

Symptoms

Due to the multistage lifecycle of the plasmodium malarial parasite, it exhibits cyclical fevers. 
The plasmodium parasite has a multistage lifecycle 
The incubation period is different for different parasites: 
Plasmodium falciparum: 8-11 days, Plasmodium vivax: 8-17 days, Plasmodium ovale: 10-17 days, Plasmodium malariae : 18-40 days 
The parasite completes its life cycle mainly in the liver and the red blood cells (RBC) 

Symptoms include: 

• Fever with chills and rigors
• Fever might be intermittent or continuous
• Fever is often associated with headache
• Muscle pains (myalgia)
• Painful joints (arthralgia)
• Loss of appetite
• Nausea and vomiting
• Diarrhea  
• Abdominal pain
• Rapid heart rate
• Rapid breathing. 

Symptoms may appear from one week to one year after infection with the parasite. 
Complications of malaria: cerebral malaria, malarial anemia, coma, or sometimes death when left untreated. 

Diagnosis

Diagnosis is mainly based on the patient's symptoms and physical findings at examination. 
Malaria is suspected mostly in individuals living in endemic areas or on recent trips to an endemic area. 
Your healthcare provider might advise the following tests complete blood picture, malarial smear, and liver function test as liver enzymes and bilirubin levels seem to be elevated in case of malaria. 
Different types of test kits are available to test for malarial antigens (i.e. malaria rapid diagnostic tests (RDT))  
A malaria smear will be done daily to check for the parasite percentage in the body. 
In a few instances, drug resistance testing will be done in-order to check for the susceptibility of anti-malarial drugs. 

Treatments

Generally, in the treatment of malaria, anti-malarial drugs will be used in combination with artemisinin known as artemisinin combination therapy (ACT) 
The anti-malarial medication dose varies depending on the patient's age, weight, and clinical condition.  
The treatment for malaria also depends on various factors like disease severity, and the species of plasmodium that infected the individual, and the chances of drug resistance for that particular species of Plasmodium.  
The treatment for malaria generally lasts for about 2 weeks. 
Your healthcare physician might also advise to get tested for G6PD (Glucose 6 phosphate dehydrogenase) test to rule out whether an individual is deficient in G6PD or not. This test is important as a few drugs used in the treatment of malaria cause hemolysis (destruction of RBC) and cause anemia. 
It is important to check for the malarial parasite smear every 12-24 hours until the parasite density becomes apparent and clinical presentation of the infected individual improves. 
Liver function test to check for bilirubin levels  
Before traveling to endemic areas, your health care professional might advise you to start prophylactic treatment for malaria with oral medications like atovaquone and proguanil 1-2 days before the departure and chloroquine may be started 1 week before the departure, and mefloquine is given on once weekly basis. 
Your healthcare provider will advise you on the antimalarial medications based on the endemic region you are traveling to, and the dosage will change for healthy adults, children, and pregnant women. You might have to take prophylaxis for 1 week after returning from the endemic region. 

Preventive Measures

The following preventive measures help in preventing malaria: 

• Use insecticide-treated bed nets when sleeping.
• Use mosquito repellents.
• Wear protective clothing.
• Prevention of stagnant water
• Diethyltoluamide (DEET) and picaridin are used as repellents for malaria prevention.
• Oil of lemon eucalyptus (OLE) is a natural plant-based oil, which when applied onto the surface of the skin acts as a mosquito repellent.
• Drain or cover the water with a cover so that mosquitoes cannot lay eggs in the water.
• Before traveling to endemic areas, your health care professional might advise you to start prophylactic treatment for malaria with oral medications like atovaquone and proguanil 1-2 days before the departure and chloroquine may be started 1 week before the departure, and mefloquine is given on once weekly basis.
• Growing Gambusia fish – it is a larvivorous fish that is used extensively in controlling mosquito breeding.
• Malaria vaccine (RTS, S/AS01) is available under the brand name Mosquirix in India. As per the World Health Organization (WHO), the malaria vaccine is given to children above 5 months to 2 years of age, in 4 doses. The first 3doses are given one month apart and the 4th dose is given after 15-18 months (about 1 and a half years) after the 3rd dose. 

Do's & Don’t's

If you suspect you may have Malaria or have risk factors for one, it is crucial to consult with a General Physician.